03070045 CITY OF CUPERTINO l :a a r�aa:+ck3�m, s �fira
aulLmnc mvlsloN PERMIT - CONTR:ACTOR INF®RMATION,
BU ILDING ADDRESS: _ KNIGHT ROOFING CO PERMIT N003070045
• OWNER'S NAME: 42035 OSGOOD RD PERMITIssueoATa
HUBBY
ONE` 5104389077 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
m.
C7 O O t�
00 LICENSED CONTRACTOR'S DECLARATION
tU F I Mmby a=rm that I am lianxd under provisions nl Chapter 9(commencing Job Description
54 wird genion)fAM))o(Division 3af Nc Busi d Professions Code,and my license is
in full forte end c(fec r� �p p p figg�..
,"z, 1 11f t3A, Lie ss '7SS7N9 REROOF 1l-0tl�'1ba"1 L�i1eaJ
F q Dau Conlrubr\ -
7W
ARCH CTS DECIdRr I V, (� 2003[, ']
undcretand my plans shall used as public records JUL 3 p OOJ
>yU s1U
5 C Licensed Professional
OWNER-BUILDER DECLARATION
i f 1 hereby affirm that I am exempt from the Cmmoactors License Lew for the BUILDING
IL.DIN
COO following mason.(Stettin 103 1.5,Business and Professions Code:Any city or county
$ which requires a permit to construct,slur,improve,demolish.or repair any atruclurt -
-ai
poor o its issuance,also myuires the applicant for such mmri t to File a signed summer,
< that he is licensed purmantto the pmvisionofineContranur'sLicenshw(Clark,9 Sq. Ft. Floor Area Valuation
i�O (commencing ori th Section 7")of Division 3 of the Business and Profession Code)or
10 that he u exempt eurefmm and the basis for me alleged exemption.Any violation of 3 5624005 . 00
Settle.7031.5 by any applicant fora permit subjects the apphcsm m a civil pcnfty of APN Number Occupancy Type
not more than five hundred dollars(SSW).
❑ I,as owner of the property,or my employees with wages ar their ole compensation,
will do the work,and the nmcwre is not intended oraffcred for sale(Sec.7De4,Business 3 U5 - RR
and Profession Code:no Conoremes License law does not apply t an owner of 3 0 7 - INSULAT IN d Inspections
property who builds or improves themun,and who doossuch work himselfor through his ..
own employ=,provided that such fmpmsemcnu arc mot intended or offeror fortis It. 6O1 - ROOF TEAR OFF
howeve building or imment proveis sold within oto year of complceon,the owner
builder will have ft burden of moving mat he did not Wild on improve for purpose of 602 - ROOF PLYWOOD NAIL
-I`')' 603 - ROOF BATTENS
❑1,construct owner of tit property,.B sine siv nd confessions Wim licensed ronb tor's fo
meLadoes noctpplycapmor ,ossane Professions Code:)oteves listed",
rad 604 — ROOF' IN-PROGRESS
cease law dors not apply to ts owner or property who sed p or improves Corton,and
whence Laces for protects with a conwctor(a)licensed pursuant to me Conoaclorl
0 1 am Law.
❑1 am exempt under Sec. .B&P C for this retort
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby M.under penalty of perjury one of the following declarefian:
I have and will maintain a Ctrtifcot of Consent to sel(-insum for Worker's Compere
-tion,u provided for by Section J?W of me labor Codc,for me performance of the
work for which this permit is issued.
1 have and will maintain Werherb Compensation Insurance,as requited by Section
1
1
00 of the labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance crier and Policy n'Ve5=��h1e-„r.art:
Carie 7Q o�y� Policy No.: '-C U07 K�
CERTIFICAFE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the permlt is forone hundred dollen(5100)
or Iess.)
I canify met in me perfnrmanee of the work for which this permit is iuuad,I shall not
employ any person in any outmost so u On become subject o dat Workers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making ibis Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of 1W Labor ends,you must
Oformwith comply with such provisions or this permit shall be deemed marked.
z'"" CONSTRUCTION LENDING AGENCY
'raw IZI I hereby affirm mu there is conswctinn lending agency for tbe performance of
7 the work for which this permit is issued(Sec.3097,Civ.C.)
�W Q Lenticrs Name
2 Lcoderl Address
O Q I canify mat 1 have read this application and am that me aWve information is
Iy F cored.l agree 10 comply with all city and county ordinances and state laws mlating to
C)U building construction.and hereby amhorm mpmsentatin3 of this city in enter upon the
W ahavo-(We) red properly for inspection purposes. vg
gy (Wt)acmeto save,indemnifyand keep hay in
the City
ruCupertinoid City �[']1L,'//%
U fag in
of the Starting
and exonerates which mryin any way scent against-id Cop
fJz in conscyucnce of the gra=ins of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat
SI,R ULATION$� /�
C1, g
Shun of Ap aav toe o, Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant tar routine building occupant store or handle hmardam metrial
Cn dcfmctl by the Cupertino Municipal Codc,Chapter 9.11,and be Health and Safety
Cu de,Section 15531(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes To
Will the applicant or future building occupant tin equipment on devices which Ifaroof is installed without first obtaining an inspection,.I agree to remove
III hazardous air contaminants as dcGned by the Bay Area Air Quality Mangemem all new materials for inspection.
Illicit? pry
❑Yes 'C No
I have mad me hazardous materials requirements under Chapter 6.95 of the Califno-
nice HcolthkSafety Code,Sauom 25505,25533 and 25534.1 undcB. tharif the Wilding
d=Our,urmn y hos a urn that it is my responsibility w nod fy the aeupmt of me �C A ///cc(T77"SSS
ri�mcnu icehlmust ttpdor In issuencesfa CcniOcate of Occupengr/ JlgnalUre Of ICanI Date
/ �- '� All roof coverings to be Class "B"or better
cr Or autht dagco T Da g
Community Development Department
Building Division
City of Cupertino
vv 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
�UPE TINO
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: I I L/9--7 L'v%d_7 /L-
Roofing Company Name: 14 K �� 2/"''�' ^9
A phcant's Signature: ( Date: 7 k 3
\�l/gWOL7�
Greg teal
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO 05
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# r^ Date:
Building Address: 11487 Lindy P1 . Cupertino
Owner's Name: Phone#:
Jack Hubby4! 408 996-2821
Contractor. , 17 License#:
Knight Roofing Co . 755799
Contact: Cupertino Business License #:
Greg Knight 21191
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
jp Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings X Provide I.C.B.O.Report# Z6 S6
❑ To be Removed ❑ Provide Mfgn Installation Specs.
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: Tear off . Install sheathing. Install Class A Duralite
Li htwei ht Tile ER-2656
Residential _Wk Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with PI Det. if
there are any restric o .
Cost of Project: 11, 480 Type of Construction: Occupancy group:
Qty.
A li if Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
oil
/7F 20